Introduction: Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decision and plan for escalation of care are essential components of holistic care for frail and elderly patients. Inappropriate resuscitation attempts in those populations lead to distress and harm. Improving communication about end-of-life care plan between healthcare professionals and patients/ families is key to delivering dignified care and reducing emergency “inappropriate crash calls”. Aim: The aim of this project was to assess and improve the completion rate of DNACPR forms and care escalation plans for patients
Background: The Comprehensive Geriatric Assessment (CGA) is a multidimensional interdisciplinary tool, designed to promote holistic care of elderly patients and provide a framework for intervention. There is evidence that the CGA reduces mortality and slows progression of frailty. Performing such interventions in the acute setting can be complex and time-consuming. Introduction: The Older Person’s Assessment Unit (OPAU) at Weston General Hospital allows early identification of frailty and prompt intervention. We aimed to promote elements of the CGA by providing a tool for utilisation
A lighter load: Tackling ACB (Anticholinergic burden) in geriatric wards: Background: Exposure to high levels of anticholinergic and sedative medications significantly increases the risk of fall-related hospitalizations, delirium, and mortality in the elderly. While the dangers of traditional anticholinergic medications are well-documented, the cumulative effects of drugs with mild to moderate anticholinergic properties often go unrecognized in everyday clinical practice. Objectives: To identify the primary contributors to anticholinergic burden (ACB) in geriatric wards and propose practical
Background: The UK National Osteoporosis Guideline Group (NOGG) guidelines 2021 recommend that all older patients presenting to geriatric clinics or wards should have a FRAX assessment guide BMD measurement and referral for DEXA or starting of drug treatment. Aims: 1) To increase the proportion of patients assessed by the acute frailty service (AFS) undergoing FRAX assessment to 85%. 2) Offer 85% of AFS patients with low-risk FRAX scores lifestyle advice. 3) Refer 85% of AFS patients with intermediate (below treatment threshold) FRAX scores for DEXA scans. 4) Refer 85% of AFS patients with
The elderly population ( cut off 65 and over, for this audit) are being increasingly prescribed direct oral anticoagulants(DOAC) for prevention of stroke in atrial fibrillation/ prevention and treatment of DVT/PE.This poses significant difficulties when stopping/ restarting these medications in the peri-operative period , due to the ever changing clinical circumstances in this period. Therefore , we performed an audit( in Glangwili Hospital, Jan-July 2024) , using the Welsh Frailty Fracture Network guidelines as our standard and found out(during the first cycle) that around 40 percent of
Introduction: Delirium is common in hospital inpatients, under-recognised, and associated with increased morbidity and mortality. NICE quality standards are that all at-risk adults newly admitted to hospital receive tailored interventions to prevent delirium. Aims: 1. To reduce time to diagnosis of delirium. 2. For 100% of patients with delirium to have tailored interventions, including behaviour/ bowel/ food charts, medication reviews, and family involvement. 3. To increase junior doctors’ confidence in recognising and managing delirium. Methods: Two changes were implemented and three cycles
Background: Delirium is a common and reversible neurobehavioral condition with significant morbidity and mortality ramifications for older patients. Consequentially, clear guidelines exist pertaining to its swift identification and management. However, studies suggest that adherence to these guidelines are poor. This audit aimed to evaluate compliance to the National Institute for Health and Care Excellence’s (NICE) delirium guidelines in an Acute Senior Health Unit (ASHU) and to present a single centre experience of a low-cost ward-based intervention for improving delirium guideline adherence